Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019.
Emergency department characteristics and associations with intensive care admission among patients with coronavirus disease 2019.
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DOI：
10.1002/emp2.12350
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发表时间：
2021-03
影响因子：
2.3
通讯作者：
Johnson N
中科院分区：
文献类型：
--
作者：
Krieger J;McGuire F;Risa E;Longino A;Coppess S;Riveros T;Hebert C;Town J;Bhatraju P;Johnson N
到目前为止，文献中很少有专门研究2019年冠状病毒病（COVID-19）患者在急诊科（艾德）就诊的描述，以及发展为危重病的患者的轨迹。在这里，我们描述了艾德在我们最初的局部激增期间出现的COVID-19患者的表现和结局。这是一项多中心、回顾性队列研究，使用从2020年3月1日至2020年6月1日期间单一卫生系统内3家医院的电子健康记录中提取的数据。如果患者在研究期间就诊于艾德，并经实验室确认患有严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染，则将其纳入研究。由经过培训的数据提取人员以电子方式从电子健康记录中提取数据元素，并输入安全数据库。我们使用多变量回归分析来检查与危重病和死亡率发展相关的艾德因素，主要结局是ICU入院。在研究期间，共有330名实验室确诊的SARS-CoV-2感染患者入院。其中，112例（34%）进入ICU。在这些患者中，20%为女性，50%为白色，中位年龄为61岁（四分位距[IQR]，52-72），中位体重指数（BMI）为28.1（IQR，24.3-35.1）。在单变量分析中，乳酸脱氢酶（LDH）（比值比[OR]，3.87; 95%置信区间[CI]，2.40-6.27）或高敏C反应蛋白（hsCRP; OR，1.32; 95% CI，1.11-1.57）高于参考范围或肌钙蛋白升高（OR，12.1; 95% CI，1.20-121.8）与ICU入院相关。校正年龄、性别和BMI后，LDH是ICU入院的最佳预测因子（OR，3.54; 95%CI，2.12-5.90）。在这些患者中，15%在住院期间需要有创机械通气，住院死亡率为19%。近三分之一因COVID-19需要住院的艾德患者入住ICU，15%接受有创机械通气，19%死亡。从艾德入院的大多数患者呼吸急促伴炎症标志物升高，以下因素与ICU入院相关：hsCRP、LDH和肌钙蛋白升高以及血氧饱和度降低和呼吸频率增加。
There have been few descriptions in the literature to date specifically examining initial coronavirus disease 2019 (COVID‐19) patient presentation to the emergency department (ED) and the trajectory of patients who develop critical illness. Here we describe the ED presentation and outcomes of patients with COVID‐19 presenting during our initial local surge. This is a multicenter, retrospective cohort study using data extracted from the electronic health records at 3 hospitals within a single health system from March 1, 2020 to June 1, 2020. Patients were included in the study if they presented to an ED and had laboratory‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection during the study period. Data elements were extracted from the electronic health record electronically and by trained data abstractors and entered into a secure database. We used multivariable regression analysis to examine ED factors associated with the development of critical illness and mortality, with a primary outcome of ICU admission. A total of 330 patients with laboratory‐confirmed SARS‐CoV‐2 infection were admitted during the study period. Of these, 112 (34%) were admitted to the ICU. Among these patients, 20% were female, 50% were White, the median age was 61 (interquartile range [IQR], 52–72), and the median body mass index (BMI) was 28.1 (IQR, 24.3–35.1). On univariable analysis, a doubling of lactate dehydrogenase (LDH) (odds ratio [OR], 3.87; 95% confidence interval [CI], 2.40–6.27) or high‐sensitivity C‐reactive protein (hsCRP; OR, 1.32; 95% CI, 1.11–1.57) above the reference range or elevated troponin (OR, 12.1; 95% CI, 1.20–121.8) were associated with ICU admission. After adjusting for age, sex, and BMI, LDH was the best predictor of ICU admission (OR, 3.54; 95% CI, 2.12–5.90). Of the patients, 15% required invasive mechanical ventilation during their hospital course, and in‐hospital mortality was 19%. Nearly one‐third of ED patients who required hospitalization for COVID‐19 were admitted to the ICU, 15% received invasive mechanical ventilation, and 19% died. Most patients who were admitted from the ED were tachypneic with elevated inflammatory markers, and the following factors were associated with ICU admission: elevated hsCRP, LDH, and troponin as well as lower oxygen saturation and increased respiratory rate.
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影响因子：
28.3
作者：
Gorbalenya, Alexander E.;Baker, Susan C.;Ziebuhr, John
通讯作者：
Ziebuhr, John
影响因子：
158.5
作者：
Sprung, Charles L.;Annane, Djillali;Briegel, Josef
通讯作者：
Briegel, Josef
DOI：
10.1164/rccm.202005-1583oc
发表时间：
2020-09-15
影响因子：
24.7
作者：
McElvaney, Oliver J.;McEvoy, Natalie L.;McElvaney, Noel G.
通讯作者：
McElvaney, Noel G.
影响因子：
15.1
作者：
Shang, Yufeng;Liu, Tao;Zhou, Fuling
通讯作者：
Zhou, Fuling
影响因子：
158.5
作者：
Papazian, Laurent;Forel, Jean-Marie;Roch, Antoine
通讯作者：
Roch, Antoine